Combo Regimen Best to Keep Obese Seniors Going

Action Points

Explain that physical function, balance, strength, and quality of life all improved significantly more in obese patients over 65 who participated in a combined diet and exercise program compared with those with no intervention or diet or exercise alone.

Note that the randomized trial was small and that most participants were women, white, and well-educated.

Exercise and weight loss both appear to help obese older adults maintain function, although combining the two provides the most benefit, a randomized controlled trial showed.

After one year, participants 65 and older who participated in both a diet and exercise program had greater gains in physical performance than those who did either one alone, according to Dennis Villareal, MD, of the New Mexico VA Health Care System in Albuquerque, and colleagues.

The combined strategy also resulted in the most consistent gains on several secondary endpoints, including strength, balance, gait, and quality of life, the researchers reported in the March 31 issue of the New England Journal of Medicine.

"Our data suggest that a major objective of weight-loss therapy in older adults may be to improve physical function, and we speculate that doing so may be at least as important as treating obesity-associated medical complications, which is often the main goal in treating obese younger adults," Villareal and his colleagues wrote.

The trial included 107 individuals 65 and older (mean age 70) who were obese, lived a sedentary lifestyle, and had mild-to-moderate frailty; 63% were women.

The researchers randomized the participants to four groups:

Control -- Individuals received no advice to change diet or activity habits, but did receive general information about a healthy diet at monthly visits. They could not participate in any weight-loss or exercise program.

Diet -- Participants were prescribed a balanced diet that cut 500 to 750 calories from their daily requirement with the goal of losing 10% of baseline body weight by six months. They attended weekly group meetings with a dietitian.

Exercise -- Individuals received information about a diet that would maintain their current weight and participated in three group exercise-training sessions a week, which included aerobic exercise, resistance training, and exercises for flexibility and balance.

The primary outcome was the change in the score on the modified Physical Performance Test, a measure of frailty consisting of nine everyday tasks. A perfect score is 36, and a mean between-group difference of 1.7 points is considered clinically meaningful.

After one year, there was a greater improvement in the score for the diet-plus-exercise group (+5.4 points) than for the diet group (+3.4 points) or the exercise group (+4.0 points). Both comparisons were significant at P<0.05.

Scores in all three groups improved more than scores in the control group (P<0.001), which remained steady.

Other measures of frailty, including peak oxygen consumption and score on the Functional Status Questionnaire, increased to the greatest extent in the diet-plus-exercise group.

Body weight dropped by 10% in the diet group and 9% in the diet-plus-exercise group, but did not change in the exercise or control groups (P<0.001).

In the exercise group, however, lean body mass increased as fat mass decreased. In the other two intervention groups, both lean body mass and fat mass decreased, although there were greater reductions in fat mass.

"These positive changes in body composition could underlie the improvement in physical function in the participants," the authors wrote.

There were smaller reductions in bone mineral density at the hip in the diet-plus-exercise group than in the diet group (1% versus 3%, P<0.05). Bone mineral density at the hip increased by 1.5% in the exercise group.

The physical component of the Medical Outcomes 36-Item Short-Form Health Survey -- a measure of quality of life -- improved in all three intervention groups.

There were a few adverse events, mostly involving exercise-related musculoskeletal injuries. One participant fell during testing of physical function, which resulted in a broken ankle.

"Careful screening and safeguards before and during exercise are needed to decrease the risk of these adverse events," the authors wrote.

They acknowledged some limitations of the study, including the lack of statistical power to examine potential differences by gender.

In addition, the generalizability of the findings to other obese older adults may be limited in that the participants volunteered for the study, were able to undergo a lifestyle intervention, had mild-to-moderate frailty, and were predominantly female, white, and well-educated.

The study was supported by grants from the NIH. One of the study authors was supported by a postdoctoral fellowship from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and a New Investigator Fellowship Initiative grant from the Foundation for Physical Therapy.

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